Provider Demographics
NPI:1396725545
Name:ZAJAC, ANDRZEJ ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:ROBERT
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:586-226-6865
Mailing Address - Fax:586-226-6880
Practice Address - Street 1:46591 ROMEO PLANK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5742
Practice Address - Country:US
Practice Address - Phone:586-226-6100
Practice Address - Fax:586-226-6101
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4381282Medicaid
MIG18309Medicare UPIN
MIN40170014Medicare ID - Type UnspecifiedMEDICARE